Hmm, I’m not quite sure what to think about this. A newly-coined term for people who are restricting food but who are not doing it for weight loss or body dysmorphia reasons. Not that new actually, as it was coined in 2013, but just being discussed a bit more.
This diagnosis is increasingly used to describe a feeding and eating disorder characterized by the restriction of adequate nutritional intake, leading to significant weight loss or failure to achieve expected growth, significant nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, and/or marked interference with psychosocial functioning. The ARFID diagnosis is not driven by a desire to lose weight or associated with distorted body image.
Medscape
The DSM-5 lists three primary presentations of ARFID: fear of aversive consequences (eg, fear of choking, vomiting, or gastrointestinal discomfort); lack of interest in eating (low appetite); and sensory sensitivity (heightened sensitivity to taste, texture, color, or smell of foods).
…When it comes to patients with ARFID and DGBI [Ed: Disordered Gut Brain Interaction ie, the Gut-Brain Axis, think vagus nerve etc], the question is, which is the chicken and which is the egg? Is ARFID behavior secondary to DGBI, meaning the patient is restricting intake in order to reduce abdominal pain? Or is DGBI secondary to ARFID, meaning, for example, that the restricted eating pattern caused constipation? In actuality, ARFID and DGBI may coexist, necessitating clearer criteria for screening and identification of such patients with these overlapping features. This would allow appropriate psychological intervention to be a component of their management.
So, we’re including people there who avoid food because it makes them feel ill. They mention gut issues, mainly, but that could extend to any food intolerance type of reaction, couldn’t it?
I sort of feel in two minds about this. Firstly: positive because doctors should start to recognise food reactions and avoidance as a problem and not just dismiss it. Plus, there is mention of the gut-brain axis being part of the problem – yes! Ergo: more recognition of food and gut brain axis problems causing issues. But second: it seems to be being classed as a disorder that needs psychological help and dismisses the very real issue of food reactions – and not just those in the gut.
We know that psychology is certainly involved, not least fear of eating because it makes you feel ill (been there and worn that T shirt massively myself over the years as you know). That’s hardly surprising – who is going to choose to eat a food that results in severe migraine, vomiting, depression, muscle pain or gut spasms for 3 days?
There’s also the learned behaviour side of things as fear makes us more stressed and more fearful. It’s a vicious circle, I know. I think CBT, or more successfully in my clinical and personal experience, brain retraining as per my Healing Plan has to be part of the picture in most cases. We have to change the neural pathways that have become habitual and develop new ones. That’s actually brain structure so not really psychological at all, of course.
What about the depression caused by the loss of food and the impact it has on our lives? That’s certainly a psychological problem but surely stemming from the food reactions in the first place?
So, in one way, at least food avoidance is being discussed more and not in the usual context of weight loss or anorexia. But they clearly have a long way to go to understand and accept the causes of food restriction as being behind actual physical change and symptoms. Surely, their best approach would be to dovetail both psychological and physical techniques? In my experience, it is nearly always both.
I’ve not even mentioned the avoidance of food due to texture, smell etc, which is, of course, a whole other ballgame and may be related to spectrum type issues with some people – autism, aspergers etc.
As per, we’ve got a name and acronym that doesn’t mean a fat lot – ARFID – but I feel hopeful that the whole area of food restriction and avoidance is at least breaking cover in mainstream medicine. At last! We just need allergy definitions to be brought up to date now and it not be all about IgE. I live in hope.
For those of you who can read Medscape, here’s the full article.